We welcome this opportunity to comment on issues raised by our colleagues on the role of government in tobacco industry litigation. Fischer and Rehm (pp. 7-8, January/February 2001 issue) argue that it is hypocritical and may be inappropriate for the state to initiate litigation against the tobacco industry. We propose a different ,tobacco logic': starting to smoke is rarely the rational act of informed adults, tobacco is not comparable to other consumer products, the government does not profit from tobacco, and litigation is a key component of a comprehensive tobacco control strategy.
Tobacco is a highly addictive drug, which most smokers begin to use as children or adolescents.' Most beginners believe they will not become addicted, yet many quickly do,2,3 and most who continue to smoke as adults are addicted. While we agree that the public is much better informed than it used to be about the dangets of smoking, we do not believe that most beginners are well informed about their own susceptibility to addiction.
No other consumer product (including vehicles, and certainly skis) kills half its long-term users, when used exactly as intended by the manufacturer. Just as industrial polluters are held responsible for the environmental damage they cause, tobacco manufacturers should be held responsible for the societal damage they knowingly cause, as manifested by at least 34,000 deaths, 194,000 hospital admissions, and $2.68 billion in health care costs annually in Canada.4,5
The misperception persists that governments profit from tobacco. In fact, conservative estimates of health costs are at least double provincial government tax revenues for tobacco.6
Litigation can be viewed as one reinforcing component of a comprehensive strategy to control tobacco use that could provide a number of benefits to public health.6 Successful litigation would likely lead to price increases by the industry to cover costs, ultimately resulting in reduced smoking and health care costs. Litigation is a public health measure that, like water treatment, is not generally practicable at the individual level.
Tobacco litigation also helps to denormalize the tobacco industry and its products, a key element (along with prevention, protection, and cessation) in Canada's National Tobacco Strategy. One of the major benefits of litigation in the United States has been the release of industry documents. Through the discovery process, we have learned about industry efforts to mislead the public, suppress research, and target youth and potential quitters.
Although the federal government and several provincial health ministries have made significant advances in tobacco control - including bans on advertising and promotion, protection from second-hand smoke, and graphic health warnings - we agree with Fischer and Rehm that other actions …